Osteoporosis International

, Volume 15, Issue 1, pp 56–61 | Cite as

Vitamin D status and its relationship with bone mineral density in healthy Asian Indians

  • Vivek Arya
  • Rajiv Bhambri
  • Madan M. Godbole
  • Ambrish Mithal
Original Article

Abstract

Synthesis of vitamin D takes place in the skin under the effect of sunlight. The Indian subcontinent is situated between 8.4° N and 37.6° N latitudes and has adequate sunshine throughout the year. Thus, it has been presumed that Indians are vitamin D sufficient. We measured serum 25-hydroxy vitamin D [25(OH)D] (n=92) and 1,25-dihydroxy vitamin D [1, 25(OH)2D] (n=65) levels in healthy hospital staff, using 125I radioimmunoassay. Serum intact parathyroid hormone (PTH) concentration was estimated by immunoradiometric assay. Bone mineral density was estimated using a dual energy X-ray absorptiometer (HologicR QDR 4500A). Using a serum 25(OH)D level of 15 ng/ml as a cutoff, 66.3% (61/92) of the subjects were found to be vitamin D deficient. Of these, 20.6% (19/92) subjects had severe vitamin D deficiency (<5 ng/ml), 27.2% (25/92) had moderate vitamin D deficiency (5–9.9 ng/ml), while 18.5% (17/92) had mild vitamin D deficiency (10–14.9 ng/ml). When a serum 25(OH)D level of 20 ng/ml was used as a cutoff, 78.3% subjects were diagnosed to be vitamin D deficient/insufficient. The serum 1,25(OH)2D level was within the normal range (40.6±20.1 pg/ml; mean ± SD). Mean (±SD) serum intact PTH, estimated in a limited number of subjects (n=15), was 72.3 (±21.0) pg/ml (range 36–100 pg/ml). There was a significant correlation between daily sun exposure and 25(OH)D levels (r=0.731, P<0.001). The serum 25(OH)D level correlated with BMD at the femoral neck and Ward's triangle (r=0.50, P=0.020 and r=0.46, P=0.037, respectively). Our findings show that vitamin D deficiency is common in urban north Indian hospital staff. The possible reasons include inadequate sunlight exposure and skin pigmentation in Indians. The serum 1,25(OH)2D level is not a good indicator of vitamin D deficiency. A low serum 25(OH)D level is possibly one of the reasons for lower bone mineral density among Indians.

Keywords

Bone mineral density Hypovitaminosis D Serum 1,25-dihydroxy vitamin D Serum 25-hydroxy vitamin D Vitamin D 

References

  1. 1.
    Webb AR, Kine L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67:373–378Google Scholar
  2. 2.
    Goswami R, Gupta N, Goswami D, Marwaha RK, Tandon N, Kochupillai N (2000) Prevalence and significance of low 25(OH)D concentration in healthy subjects in Delhi. Am J Clin Nutr 72:472–475PubMedGoogle Scholar
  3. 3.
    Alekel DL, Mortillaro E, Hussain, et al (1999) Lifestyle and biologic contributors to proximal femur bone mineral density and hip axis length in two distinct ethnic groups of premenopausal women. Osteoporos Int 9:327–338CrossRefPubMedGoogle Scholar
  4. 4.
    Sheran E, Newton O, Ali HA, Walford S, Singh BM (1999) Prevalence of hypovitaminosis D in Indo-Asian patients attending a rheumatology clinic. Bone 25:609–611PubMedGoogle Scholar
  5. 5.
    Fuleihan GE, Deeb M (2000) Hypovitaminosis D in a sunny country. N Eng J Med 340:1840–1841CrossRefGoogle Scholar
  6. 6.
    Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: Consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501PubMedGoogle Scholar
  7. 7.
    Holick MF (1994) McCollum Award Lecture: vitamin D: new horizons for the 21st century. Am J Clin Nutr 60:619–630PubMedGoogle Scholar
  8. 8.
    Mithal A, Nangia S, Arya V, Verma BR, Gujral RB (1998) Spinal bone mineral density in normal Indian females. J Bone Miner Res [Suppl]:S591Google Scholar
  9. 9.
    Webb AR, Pilbeam C, Hanafin N, Holick MF (1990) An evaluation of the relative contributions of exposure to sunlight and to diet to the circulating concentration of 25 hydroxyvitamin D in an elderly nursing home population of Boston. Am J Clin Nutr 51:1075–1081PubMedGoogle Scholar
  10. 10.
    McKenna MJ (1992) Differences in Vitamin D status between countries in young adults and the elderly. Am J Med 93:69–77PubMedGoogle Scholar
  11. 11.
    Lips P, Duong T, Oleksik A, et al (2001) A global study of vitamin D status and parathyroid function in postmenopausal women with osteoporosis: baseline data from the Multiple Outcomes of Raloxifene Evaluation clinical trial. J Clin Endocrinol Metab 86:1212–1221Google Scholar
  12. 12.
    Chapuy MC, Preziosi P, Maamer M, et al (1997) Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int 7:439–443CrossRefPubMedGoogle Scholar
  13. 13.
    Thomas MK, Lloyd-Jones DM, Thadhani RI, et al (1998) Hypovitaminosis in medical in patients. N Engl J Med 338:777–783PubMedGoogle Scholar
  14. 14.
    Tangpricha V, Peerce EN, Chen TC, Holick MF (2002) Vitamin D insufficiency among free-living healthy young adults. Am J Med 112:659–662PubMedGoogle Scholar
  15. 15.
    Preece MA, Ford JA, McIntosh WB, Dunnigan MG, Tomlinson S, O'Riordan JLH (1973) Vitamin D deficiency among Asian immigrants to Britain. Lancet 1:907–910PubMedGoogle Scholar
  16. 16.
    Malabanan A, Veronikis IE, Holick MF (1998) Redifining vitamin D insufficiency. Lancet 351:805–806Google Scholar
  17. 17.
    Lo CW, Paris PW, Holick MF (1986) Indian and Pakistani immigrants have the same capacity as Caucasians to produce vitamin D in response to ultraviolet irradiation. Am J Clin Nutr 44:683–685PubMedGoogle Scholar
  18. 18.
    Chel VG, Ooms ME, Popp-Snijders C, et al (1998) Ultraviolet irradiation corrects vitamin D deficiency and suppresses secondary hyperparathyroidism in the elderly. J Bone Miner Res 3:1238–1242Google Scholar
  19. 19.
    Haddad JG Jr, Hahn TJ (1973) Natural and synthetic sources of circulating 25-hydroxy-vitamin D in man. Nature 244:515–517Google Scholar
  20. 20.
    Reinhold JC, Lahimgarzadeh A, Nasr K, Hedyati H (1973) Effect of purified phytates and phytate-rich bread upon metabolism of zinc, calcium, phosphorus and nitrogen in man. Lancet 1:283–287PubMedGoogle Scholar
  21. 21.
    Awumey EMK, Mitra DA, Hollis BW, Kumar R, Bell NH (1998) Vitamin D metabolism is altered in Asian Indians in the southern United States: A clinical research centre study. J Clin Endocrinol Metab 83:169–173Google Scholar
  22. 22.
    Bouillon RA, Auwerx JH, Lissens WD, Pelemans WK (1987) Vitamin D status in the elderly: seasonal substrate deficiency causes 1,25-dihydroxycholecalciferol deficiency. Am J Clin Nutr 45:755–763PubMedGoogle Scholar
  23. 23.
    Villareal DT, Civitelli R, Chines A, Avioli LV (1991) Subclinical vitamin D deficiency in postmenopausal women with low vertebral bone mass. J Clin Endocrinol Metab 72:628–634Google Scholar
  24. 24.
    Scharla SH, Scheidt-Nave C, Leidig G, et al (1996) Lower serum 25-hydroxyvitamin D is associated with increased bone resorption markers and lower bone density at the proximal femur in normal females: a population-based study. Exp Clin Endocrinol Diabetes 104:289–292Google Scholar
  25. 25.
    Gupta A (1996) Osteoporosis in India. The nutritional hypothesis. Nat Med J India 9:268–274Google Scholar
  26. 26.
    Harju E, Sotaniemi E, Puranen J, Lahti R (1985) High incidence of low serum vitamin D concentration in patients with hip fracture. Arch Orthop Trauma Surg 103:408–416PubMedGoogle Scholar
  27. 27.
    Ng K, St John A, Bruce DG (1994) Secondary hyperparathyroidism, vitamin D deficiency and hip fracture: importance of sampling times after fracture. Bone Miner 25:103–109PubMedGoogle Scholar
  28. 28.
    Chapuy MC, Arlot ME, Duboeuf F, et al (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327:1637–1642PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Vivek Arya
    • 1
  • Rajiv Bhambri
    • 2
  • Madan M. Godbole
    • 1
  • Ambrish Mithal
    • 2
  1. 1.Department of EndocrinologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of Endocrinology and DiabetesIndraparastha Apollo HospitalNew DelhiIndia

Personalised recommendations